Hi Bryanna,

About 15 years ago I had an upper roundhouse bridge installed. It was done in thirds. For the last couple of years, the back third has started to loosen and I avoid chewing on that side of my mouth since it is painful and I worry that the whole thing will fall out.

Six months ago I saw a prosthodontist who is on my dental plan's panel and he said that on my next appointment he would discuss a treatment plan for this part of the bridge.

My question is this: Is it better to opt for implants on this part of the bridge or should I just go ahead and replace it with new crowns as was done originally?

Also, are implants used as anchors for crowns...ie, is it possible to have say, two implants to support four crowns?

Thanks for your help.

Hi antonina,

A roundhouse bridge generally means that all of the teeth (fake or real) are connected to each other. Your description sounds like you have three separate bridges in your upper arch..... is that correct?

The fact that the one bridge has been loose for a couple of years means that it was either ill fitting right from the start..... or the cement seal did not last very long...... or decay developed on a tooth/teeth underneath the bridge. Whatever the reason, there is a good chance that at this point there is decay and the severity of it can only be deterimined by removing the bridge and evaluating the teeth clinically and radiographically.

The answer to your replacement question is...... it all depends on the health of those teeth underneath the bridge. If they are healthy and the decay can be restored with filling material then a new bridge can be made. If they are not healthy, then you may be given the options of having root canals or extractions. If you opt for root canals then a new bridge will be made similar to what you have now. If you opt for extractions, then it all depends on how many teeth are removed as to whether a new bridge can be made without doing an implant. All bridgework requires anchor teeth. These anchor teeth can be dental implants.

Yes, two implants can support 4 crowns on a bridge.

My thoughts to you are this....... it is imperative to have healthy teeth, bone and gums when talking about bridgework. If the bridge is anchored onto unhealthy teeth, the bridge will fail. If there is gum disease and moderate bone loss, unless the disease is brought under control and the home care is impeccable, the bridge will fail. Root canaled teeth are unhealthy teeth in that they will always carry infectious bacteria in their microscopic canals called the dentin tubules or accessory canals. These teeth always require retreatment or extraction at some point. To anchor a bridge onto root canaled teeth is an issue that will need to be readdressed at sometime in the future. Dental implants placed in a healthy person in healthy bone are meant to last a lifetime if they are maintained daily with proper oral hygiene.

I would suggest that you see what the prosthodontist has to say and pick his brain for options. Make sure you discuss the health of the teeth, the bone and the gums. I am going to give you an experienced inside view to prosthodontics...........this is not meant to demean this specialty just make you aware that very frequently these dentists build their work on unhealthy teeth. Why? Because they tend to see the esthetic portion of their work more so than the stability of it. I know that sounds crazy, but it's unfortunately true. So please keep that in mind and ask him many questions about the health of your mouth before you accept his final treatment plan.

I hope this info was helpful to you. Please let us know if you have any more questions and certainly keep us posted on how things go!

Bryanna

Hi Bryanna,

Thank you for such a thorough and informative response.

It's interesting to learn that I don't have a "roundhouse," which is what the supervising dentists at Columbia Graduate Dental School prosthodontic clinic called it. I made a horrible mistake going there. It took five years for them to get it right. Or, maybe they didn't get it right after all. It was sheer hell going there every two weeks, but that's another story.

This time around I have enough funds to pay a non dental plan private practitioner. From what you wrote, I believe there must be lots of decay underlying the failing bridge. When I accidentally chew on it, it's quite painful.

So if there is extensive decay/infection, I think my problem is to find someone who is top notch. The plan dentists are OK for routine stuff but maybe not for more complex cases.

My question: should I go back to the plan doc to see what he recommends and then try to find someone with possibly more expertise who can offer a second opinion?

Hi antonina,

Yet another dental school nightmare....... I am so sorry :-( I see the work that comes out of some dental schools and it just makes me want to cry. People think they are getting a bargain...... supervised, quality dentistry at a great price. Unfortunately, that is usually not the case at all. The treatment takes so long and the plan changes so many times along the way..... all to end up eventually being redone anyway. I wish this was not an accepted form of dental care, but believe it or not, it is considered standard of care.

I agree with you in that it may be wise to see your in network dentist for his plan (but be leary of that type of financially controlled dentistry also) and get a second opinion from a reputable dentist outside of your plan.

The term roundhouse in dentistry means bridgework that is all connected and it covers one side of the arch to the other. Your bridgework is in three pieces and it goes from one side of the arch to the other. Some dentists may refer to this as a roundhouse but in the true sense it is simply three bridges.

Please don't get yourself upset over what could be lerking underneath your bridgework. It may just be ill fitting and that's why it hurts to chew on. Radiographs and clinical evaluation will help tell the story.

Please keep in touch with us......

Bryanna